从痰论治激素性股骨头坏死OPG/RANK/RANKL 信号调控机制研究进展

汪小敏1，曹林忠 1，宋敏 1，李俊 2，赵希云 1，刘新宇 1，苏亮磊 1

1.甘肃中医药大学，甘肃 兰州 730000；2.兰州大学，甘肃 兰州 730000摘要：近年来，激素的不规范使用导致激素性股骨头坏死（SANFH）的发病率呈上升趋势。中医药防治SANFH 疗效确切，受到广泛关注，但由于缺乏药效学机理的分子生物学依据，尚未达到标准化治疗水平。OPG/RANK/RANKL信号通路的发现，为临床防治骨代谢疾病开辟了新途径。该信号通路与SANFH“脾虚生痰-由痰致瘀-因瘀致痹”的病机演变密切相关，从痰论治 SANFH 的分子生物学效应最终可通过该信号通路调控的微观信息来表达。本文探讨从痰论治 SANFH 与 OPG/RANK/RANKL 信号调控机制的相关性，结合骨代谢调控机制探讨SANFH的中医辨治，为临床及深入研究提供依据。关键词：激素性股骨头坏死；OPG/RANK/RANKL信号通路；从痰论治；机制；综述

DOI：10.3969/j.issn.1005-5304.2017.10.036

中图分类号：R272.968.1 文献标识码：A 文章编号：1005-5304(2017)10-0133-04

Research Progress in OPG/RANK/RANKL Signal-regulated Mechanism of Steroid Induced Avascular Necrosis of Femoral Head from Phlegm Theory

WANG Xiao-min1, CAO Lin-zhong1, SONG Min1, LI Jun2, ZHAO Xi-yun1, LIU Xin-yu1, SU Liang-lei1 (1. Gansu University of Chinese Medicine, Lanzhou 730000, China; 2. Lanzhou University, Lanzhou 730000, China)

Abstract: In recent years, due to the irregular and abused use of glucocorticoid in clinical treatment, the incidence of steroid induced avascular necrosis of femoral head (SANFH) is gradually increasing. TCM for the prevention and treatment of SANFH has received much attention from many scholars. However, due to the lack of the scientific explanation of molecular biology level for its pharmacodynamics mechanism, it is difficult to achieve the purpose of standardized treatment. The discovery of OPG/RANK/RANKL signaling pathway has opened up new shortcuts for the prevention and treatment of bone metabolic diseases. OPG/RANK/RANKL signaling pathway is associated with the pathogenesis of “spleen deficiency and phlegm - blood stasis caused by phlegm-blood stasis due to paralysis” of SANFH. The treatment efficacy based on the phlegm theory can eventually axial control of the system through the micro-information to express. This article discussed the relevance between the “phlegm” in the treatment of SANFH and molecular biology mechanism of OPG/RANK/RANKL signal regulation mechanism, and combined the system of bone metabolism regulation mechanism to discuss TCM differentiation of SANFH, with a purpose to provide references for clinical and further study.

Key words: steroid induced avascular necrosis of femoral head; OPG/RANK/RANKL signaling pathway; phlegm theory; mechanism; review

激素性股骨头坏死（ steroid induced avascular necrosis of femoral head，SANFH）是由于糖皮质激素（glucocorticoid，GC）大剂量应用致使骨内循环障碍、

基金项目：甘肃省自然科学基金（1308RJZA293）；甘肃省卫生

行业科研管理项目（GWGL2014-65）；甘肃中医药大学中青年

基金（ZQ2014-13）

通讯作者：曹林忠，E-mail：clzh1@163.com 骨代谢失衡，破坏股骨头局部血运，引起缺血坏死，继而导致股骨头塌陷、骨折的一种骨代谢性疾病。激素和酒精是引起非创伤性股骨头坏死的主要因素，近年来，由于 GC 不规范使用，SANFH 的发病率日渐升高，居非创伤性股骨头坏死的首位，其起病隐袭、病情发展快、致残性强，已成为困扰医患的重大公共难题。

根据发病部位、临床症状等特点，SANFH 可归